AUA 2017: The impact of anxiety and depression on functional outcome in patients who underwent radical prostatectomy

Boston, MA ( Mental health illnesses present a sizable comorbidity for prostate cancer (PC) patients undergoing radical prostatectomy (RP), particularly with regard to functional outcomes such as those of urinary incontinence and erectile dysfunction. Quality of life (QoL) post-RP is severely impacted by wearing 1 or more (security) pads or any degree of erectile function. Within this context, Dr. Raisa Pompe assesses the impact of both depression and anxiety on PC patients’ subsequent QoL.

From 2004 through 2016, 3,890 patients undergoing RP for the treatment of PC were retrospectively analyzed. Patients undergoing adjuvant radiation therapy within 1 year of RP date were excluded from all analysis, while patients who underwent subsequent androgen deprivation therapy (ADT) within 1 year were excluded from only analysis of erectile dysfunction. The Patient Health Questionnaire (PHQ) was used to assess the degree of depression and anxiety patients experienced prior to surgery: 0-2 being normal, 3-5 mild, and greater than 6 as moderate to severe. Study endpoints were defined as zero or security pad for continence and greater than 2 on component 2 of the International Index of Erectile Function-5 (IIEF-5).

After adjusting for covariates such as age, BMI, nerve-sparing technique, and pathological tumor stage, a higher PHQ-4 core at 1-week and 1-year corresponded with a lower proportion of men obtaining urinary continence status (OR 1.42 and 1.99, respectively). Erectile function, however, showed no significant differences with PHQ-4 scores, though patients with a score greater than 5 were more likely to use PDE-5 inhibitors and intracavernous injection therapies.

Overall, depression and anxiety are significantly associated with the proportion of patients achieving urinary continence post-RP. While there were no correlations found in erectile function recovery, an increased use of PDE-5 inhibitors and intracavernous injection therapies suggests some level of interaction between erectile function and depression / anxiety. A full analysis of the IIEF-5 may further elucidate associations for future study direction.

Presented By: Raisa Pompe, University Hospital Hamburg-Eppendorf

Author(s): Raisa Sinaida Pompe, Alexander Krueger, Pierre I. Karakiewicz, Philipp Mandel, Philipp Gild, Sami-Ramzi Leyh-Bannurah, Georg Salomon, Hartwig Huland, Markus Graefen, Derya Tilki,

Affiliation: University Hospital Hamburg-Eppendorf

Written By: Linda Huynh (BS), an assistant research specialist from the University of California, Irvine, on behalf of

at the 2017 AUA Annual Meeting - May 12 - 16, 2017 – Boston, Massachusetts, USA